In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. A 17-year-old patient presents with a “twisted” left knee sustained in a fall, able to bear weight despite obvious pain. View the image taken (Figure 1) and …
Read More
The Case of a 51-year-old Man with Back Pain
Most new third-year medical students can recite the “red flags” of back pain: extremes of age, fever, history of cancer, history of trauma, failure to improve after one month of therapy. Few would fail to consider metastatic disease in a 64-yearold woman with a history of breast cancer and new-onset low back pain, but what about the 51-year-old male without a significant past medical history?
Read More
14-year-old boy with lower back pain stemming from fall
The patient is a 14-year-old boy who presents with low back pain after falling from “a high height” and landing on his feet. Exam is normal except for tenderness in the mid-lumbar region. View the image taken and consider what your diagnosis and next steps would be.
Read More
17-year-old boy injures knee during a fall
The patient is a 17-year-old boy who experienced a blow to the right knee in the course of a fall. He complains of pain over the knee and is unable bear weight on the leg. On examination, you find local swelling. View the image taken and consider what your diagnosis and next steps would be.
Read MoreClinical Challenge 2: September 2010
The patient is a 32-year-old man who presents after experiencing a blow to the face while falling from a bicycle. The patient complains of tenderness over the front of his face. Neurological exam is normal. You note that his neck is supple. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreInvesting in Expansion: Do It Yourself, or Take on Investors?
Urgent message: Sound finances and proven business management skills may be the most valuable assets for the urgent care operator looking to capitalize on past successes by expanding. by Michael Gotlieb Introduction Urgent care owners, like many other entrepreneurial businesspeople, have great opportunities in front of them, yet need assistance at times. Sometimes, that “assistance” is purely financial. Most often in inflection point cases like expansion; however, it is a combination of financial and business acumen …
Read More
37-year-old diabetic female feeling weak after switching diuretics
The patient is a 37-year-old female who presented with a history of longstanding hypertension and diabetes mellitus. She had recently started on a new diuretic, and felt very weak and lightheaded. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. After reviewing the ECG, consider the following questions: 1. Based on this ECG, what type of diuretic is she likely to be taking? 2. How should she be managed?
Read More
September 2010
Abstracts in Urgent Care: September, 2010
Non-intravenous Midazolam Effectively Terminates Pediatric Seizures Key point: A meta-analysis revelas that non-IV midazolam is as effective as or superior to IV or rectal diazepam for stopping seizures in children and young adults. Citation: McMullan J, Comilla S, Panciolo A, et al. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med. 2010; 17(6): 575-582. Although intravenous (IV) lorazepam is considered first-line therapy for status epilepticus, …
Read MoreDeveloping Data: September, 2010
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we present data that shed light on reasons parents may be taking their children to the emergency room instead of to their pediatricians, even for non-urgent care. Researchers at Columbia University Medical Center in New York City report that between 1997 and 2006, there’s been a shift in those reasons; where perceived need for …
Read More